Contents

National Guidance on Managing Head Lice Infection in
Children

Annex 2 Head lice: notes and guidance for pharmacists

General

Head louse infection is not primarily a problem of schools
but of the wider community.

Pharmacists are an important source of advice on the
management of head louse infection. They should be
knowledgeable and competent on the subject, be able to teach
patients the technique of detection combing, and be prepared to
advise appropriate treatment.

Pharmacists have an especially important role in limiting
chemical treatment to true cases of infection, reducing
unnecessary and inappropriate treatment, and thereby reducing
the risk of further development of resistant strains of
lice.

Health professionals should be able to identify a louse at
all stages of its development.

Patients should be made aware that head lice are only
transmitted by direct, head to head contact.

Specific

If practical, consider nominating a member of staff to be
responsible for advising patients on head louse problems.

Liaise, as appropriate, with your local family practices,
school nurses, health visitors, head teachers, infection
control nurses, early years services and Consultant in Public
Health Medicine.

Where possible, stick to the following principles of
control:

definite diagnosis; a living, moving louse found by
detection combing;

simultaneous thorough and adequate treatment of all
confirmed cases with one of the standard chemical insecticidal
lotions and a repeat of the treatment after seven days, or the
use of the wet combing method, also known as 'bug busting'
every 3 days for up to 3 weeks. Ensure that patients are
provided with information, advice and support. At a first
consultation, it may be sufficient to ensure that they know how
to undertake detection combing and what to do if there are head
lice present.

Do not assume a patient has head lice unless you yourself
have seen a living, moving louse, or you have physical evidence
from the patients; ask them to stick one of the lice on a piece
of paper with clear sticky tape and bring it in.

Make every effort to discourage unnecessary or inappropriate
treatment with insecticides.

Only recommend treatment if a louse has been clearly
identified (as described above).

Ensure that patients know the correct use of insecticidal
lotions - follow the British National Formulary's
recommendation of two applications of the same lotion ( not
shampoo), seven days apart.

Do not assume that "reinfections" or "treatment failures"
are truly infections. Make sure that a louse is found or
produced.

Do not recommend re-treatment without first of all
establishing that living, moving lice are still present after
two applications of the same lotion seven days apart and after
a full professional assessment as to the ways in which the
family may not have complied carefully with the first
attempt.

Generally, Malathion or one of the pyrethroids is considered
as first line treatment, and Carbaryl as second line treatment.
There is little resistance so far to Carbaryl, but it is
available only on prescription.

Bear in mind that different formulations of the same active
ingredient may be differently efficacious. When a first
treatment has definitely failed, it may be useful to try the
same agent in a different formulation.

The use of electronic combs, repellent sprays, or chemical
agents not specifically licensed for the treatment of head
louse infections, should not be supported.

Ensure that you can provide patients with an effective
detection comb. This will have rigid plastic teeth set not more
than 0.3mm apart.

Do provide advice and support to families who do not wish to
use insecticidal lotions.

The 'Bug Buster Kit' is now available for prescribing by health
professionals. Only one kit is required for a family and it is
reusable. The kit, which includes an illustrated guide and combs,
is available from some pharmacies and by mail order from: